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NON-HAZARDOUS 1. Generator's US EPA ID No. Manifest Doc.No. 2. Paged <br /> WASTE MANIFEST . . . . . . of <br /> 3. t3eneretor's Name and mailing Address <br /> � �-"^'f,�-fid�e/��..`� C�c.4.� p[.�''�J.• <br /> 4. Generators Phone( ) 4/v'9po25's <br /> 5 <br /> 5. Transpo er i Company Name 6. US EPA ID Number A. Transporter's Phone <br /> 7. Transporter 2 Company Namtf 8. US EPA iD Number B. Transporter's Phone <br /> 9. Designated Facility Name and Site Address 10. US EPA ID Number C. Facility's Phone <br /> ALTAMONT LANDFILL <br /> 10840 ALTAMONT PASS RD. <br /> LIVERMORE, CA 94550 C.A.D.9.8.1 .3.8.2.7.3.2 (925)449-6349 <br /> 11.Waste Shipping Name and Description 12. Containers 13. 14. <br /> Total Unit <br /> No. Type Quantity WWoI <br /> a. <br /> q b. <br /> E <br /> N <br /> E <br /> R <br /> A c. <br /> T <br /> O <br /> R <br /> d. <br /> D. Additional Descriptions for Materials Listed Above E. Handling Codes for Wastes Listed Above <br /> 15.Special Handling Instructions and Additional Information <br /> PROFILE#,g5gj2� Ri&n=*:_(,-W,,9<, <br /> CUSTOMER NAME Lt . �.-�s <br /> 15.GENERATOR'S CERTIFICATION: I certify the materials described above on this manifest are not subject to federal regulations for reporting proper disposal of Hazardous Waste. <br /> Printed/Typed Nme Sign Month Day Year <br /> a I L.) <br /> TR 17.Transporter 1 Acknowled44ent of Receipt of Materials <br /> N Prints yped N e re Month Day Year <br /> P �^i 2 <br /> RO 18.Transporter 2 Ac nowledgement of Reoelpt of Materials <br /> E Printed/Typed Name Signature Month Day Year <br /> R <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> I <br /> 20.Facility Owner or Operator:Certification of receipt of waste materials covered by this manifest except as noted In Item 19. <br /> T <br /> Y Printed/Typed Name Signature 9 - Month Day Year <br /> ..3 ORIGINAL-RETURN TO GENERATOR J <br />